Abstract: #AbortionChangesYou: A Case Study to Examine the Communicative Tensions in Women's Medication Abortion Narratives

◆ Katherine Rafferty, Iowa State University
◆ Tessa Longbons, Charlotte Lozier Institute

One out of four women will undergo an abortion procedure in the United States by age 45. While abortion rates are steadily declining in the United States, the rate of medication abortions continues to increase. In 2000, the U.S. Food and Drug Administration approved mifepristone to be used in combination with misoprostol as a form of medication abortion, and since then, the annual number of medication abortions has risen steadily. Currently, over one-third of all abortions in the U.S. are medication abortions (Guttmacher Institute, 2019). Between 2014-2017, the number of medication abortions provided at facilities other than hospitals increased by 25% (Jones, Witwer, & Jerman, 2019). In addition, the 2016 FDA protocol update expanded provider eligibility for dispensing mifepristone to women. Thus, abortion provision is transitioning from formalized medical procedures conducted in health care settings to a protocol in which most of the abortion process occurs individually at home with limited assistance from a clinician (Biggs, Ralph, Raifman, Foster, & Grossman, 2019). Given these significant changes to abortion provision, more research is needed to examine the distinct experiences of women who have undergone this type of abortion. Our study is one of the first to analyze women’s unsolicited blogging narratives after having had a medication abortion.

Method & Findings
Using relational dialectics theory as a framework, we conducted a case study of the nonpartisan website, Abortion Changes You. We were interested in understanding the topics women disclosed to the "generalized other," and what "if any" sites of struggle characterize the communication within women's online blog post. Our contrapuntal analysis rendered four primary sites of dialectical tension found across the 98 different blog posts: only choice vs. other alternatives, unprepared vs. knowledgeable, relief vs. regret, and silence vs. openness. Each site of struggle characterized a different noteworthy moment within a women’s medication abortion experience: the decision, the medication abortion process, post-abortion identity, and managing the stigmatizing silence before and after the abortion.

Theoretical & Practical Implications
Our findings show that the abortion experience is ripe with communicative tension and less of an absolute. This complexity and duality is not evident in much of the centripetal cultural discourses about abortion. Many women in this case study noted that their decision to have a medication abortion was not a flippant decision or an easy choice where women remained unscathed. Women’s narratives about their medication abortion experiences were more complex, and no singular narrative fully encapsulates or defines a women's medication abortion experience during or post-abortion. Therefore, it is critical to transcend the shouting and silence alike in order to expose both sides of the debate and understand how these larger discourses influence women’s personal language choices when constructing their own abortion narrative and putting their experience into words. The dialectical struggles with having a more private medication abortion and talking openly about it afterwards remain silent from current public discourse and debate (Hallgarten, 2018).